Coverage Expansion Through Age 29
Who is eligible?
In order to participate, the “Age 29” law requires the coverage, the young adult’s parent, and the young adult to meet certain requirements.
The coverage must:
- Be a group or group remittance health insurance policy that includes coverage for dependents;
- Be issued in New York State and subject to New York State laws; and
- Be fully insured (this benefit does not apply to self-funded plans).
Please contact your employer, employee benefits administrator or insurance company to find out what state laws apply to the policy and if your coverage is fully insured.
The parent must be covered under the group policy as an employee or member of the group or pursuant to a right under the federal Consolidated Omnibus Budget Reconciliation Act (COBRA) or state continuation coverage law.
The Young Adult
The young adult must:
- Be unmarried;
- Be 29 years of age or under;
- Not be insured by or eligible for comprehensive (i.e., medical and hospital) health insurance through his or her own employer;
- Live, work or reside in New York State or the health insurance company’s service area; and
- Not be covered under Medicare.
Please note that the young adult does not have to live with a parent, be financially dependent on a parent, or be a student.
When does this law take effect?
The law affects policies or contracts issued, renewed, modified, altered or amended on or after September 1, 2009. For most existing policies, young adults and their parents will be able to access the young adult option once the right attaches to the policy. For most policies, this will happen on the policy's first renewal date on or after September 1, 2009. You can contact your insurer or group administrator to determine the renewal date. The young adult option must be included with all new policies issued on or after September 1, 2009.
Who will notify me of this benefit?
The insurer will provide written notification to group members or employees (not young adults) in each certificate of coverage and at least 60 days prior to the date the young adult who is covered as a dependent under the parent's policy would otherwise have coverage terminate due to reaching the maximum age for dependent coverage.
Insurers must also notify employees or group members of the initial 12-month open enrollment period, which runs for 12 months following the date that coverage through the young adult option becomes available under the policy or contract.
If you think that you are eligible for this benefit but your parent did not receive notice, please contact your parent's insurer.
When may I enroll?
There are four times when you may enroll:
- When You Would Otherwise Age Off a Policy
If you are currently covered under a parent's group policy, you may enroll within 60 days of the date that your coverage would otherwise end due to reaching the maximum age for dependent coverage. Coverage will be retroactive to the date that your coverage would otherwise have terminated.
- When You Experience a Change in Circumstances
You may enroll within 60 days of newly meeting the eligibility requirements. Coverage will be prospective and will start within 30 days of when your parent's employer or group administrator receives notice of your election and premium payment. Examples of changes in circumstance would be a young adult moving back to New York State after living outside the state or losing health insurance coverage sponsored by an employer.
- During an Annual 30-Day Open Enrollment Period
Your parent's insurer will have an annual 30-day open enrollment period. If you meet the eligibility requirements, you may elect coverage during this period. Coverage will be prospective and will start within 30 days of when your parent's employer or group administrator receives notice of your election and premium payment.
- During the Initial 12-Month Open Enrollment Period
There is an initial 12-month open enrollment period, which should run for 12 months following the first renewal of the health insurance policy or contract on or after September 1, 2009. If you meet the eligibility requirements during this initial 12-month open enrollment period, you may enroll during this time. Coverage will be prospective and will start within 30 days of when your parent's employer or group administrator receives notice of your election and premium payment.
If I elect this benefit, when will my coverage start? Will it be retroactive to the last time that I had coverage?
Coverage will be retroactive if you elect it within 60 days of the date that you would otherwise age off a parent’s policy. In all other cases, coverage will be prospective and will start no more than 30 days from the date that the insurer receives notice of your election and premium payment.
What is the cost?
The young adult or his or her parent will be responsible for a separate premium for the young adult option (over and above what the parent pays for the group coverage).
How do I enroll?
To enroll, you should notify your parent's employer or benefits administrator in writing and include payment of the first month's premium. Contact the plan administrator or insurer to find out the amount of the premium.
Does this law apply to self-funded plans?
No, it does not apply to self-funded/self-insured plans, due to federal preemption under the Employee Retirement Income Security Act (ERISA). You can contact your employer, benefits administrator or insurance company to determine if your plan is self-funded.
Does the young adult option apply to municipal cooperatives?
Yes. The young adult option is available to coverage through a municipal cooperative.
Does the young adult option apply to Healthy NY?
The young adult option is available to coverage through a group Healthy NY policy.
Are there any other insurance plans that this law does not apply to?
The law does not apply to dental only, vision only, pharmacy only, accident only or specified disease coverage.
I have a child. Does this make me ineligible?
Young adults with children may make an "Age 29" election if they meet the eligibility criteria. However, young adults' children cannot be covered under the "Age 29" law. If you need to cover your children, you may want to consider Child Health Plus. Child Health Plus is available at a reduced premium to children in families who are up to 400% of the Federal Poverty Level ($58,280 for a family of two) and at full price for children above that level.
I am eligible for coverage through my employer, but it has very poor benefits. Am I eligible for the “Age 29” benefit?
If your employer provides health insurance that includes both medical and hospital benefits, whether insured or self-funded, then you cannot make an "Age 29" election. If your employer provides coverage that does not include both medical and hospital benefits, then you may be eligible if you meet the other requirements.
I am eligible for COBRA/state continuation coverage from my former employer. Am I eligible?
Yes, as long as you meet the other requirements for the young adult option. You can elect COBRA/continuation coverage through your employer or you can instead make an "Age 29" election. You should weigh your options carefully before making a decision. Keep in mind that it may be better for you to exhaust COBRA/state continuation before making an "Age 29" election. This is because if you have coverage pursuant to an "Age 29" election and your parent loses eligibility for group coverage or you no longer qualify as a young adult, your coverage would terminate and you would not have a separate right to COBRA/state continuation under that group policy. However, if your parent loses eligibility for group coverage and you have COBRA/state continuation coverage, your coverage would not terminate. You should also consider the pros and cons of each type of coverage, including determining what benefits each plan covers, what your out-of-pockets costs would be, and whether your doctors or providers are in the network, if applicable.
I am covered through an individual policy that I purchased on my own. May I still make an "Age 29" election?
If you have coverage as an individual, then you may make an "Age 29" election if you meet the eligibility requirements. If you have coverage through your employer, then you cannot make an "Age 29" election, because you have employer-sponsored insurance.
My parent's employer offers family coverage, but my parent currently has self-only coverage. Does that prohibit me from making an "Age 29" election?
No. You or your parent may make an "Age 29" election even though your parent does not have family coverage.
If my parent separates from his or her employer or group and is no longer eligible for health insurance, am I eligible?
No. If this occurs, then you would lose the right to the young adult option.
If my parent has COBRA/state continuation coverage, am I eligible?
Yes, you are still eligible while your parent has COBRA/state continuation coverage, if you meet the eligibility requirements.
I had “Age 29” coverage and then it ended because I no longer met the eligibility requirements. My situation has changed, and I meet the eligibility requirements again. Can I get “Age 29” coverage again?
Yes. You are not limited to having this coverage only once. You may elect it within 60 days of newly meeting the requirements or during the annual 30-day open enrollment period.
If I exhaust my benefits under the “Age 29” law, may I elect COBRA or state continuation coverage and receive an additional 36 months of coverage?
No. When your coverage under the "Age 29" young adult option terminates, you would not have a COBRA/state continuation right at that time.
Can the parent enroll the young adult in the young adult option?
Yes. Parents may enroll their young adults in the option for them.
If my parent’s employer offers several different benefit packages, do I get to choose which one I want?
Insurers and employers are not required to offer different benefit packages for the young adult option.
I have “Age 29” coverage but cannot make my premium payment on time. Is there a grace period?
Yes. There is a 30-day grace period. If you do not make full payment within the 30-day grace period, then your coverage will be terminated back to the date that the last premium payment was paid.
When will coverage end?
Coverage will end when one of the following occurs:
- You terminate your coverage pursuant to the terms of the policy.
- Your parent is no longer enrolled in group health insurance coverage, including COBRA/state continuation coverage.
- You no longer meet the eligibility requirements.
- You do not pay the premium in full within the grace period.
- The group insurance policy is terminated and not replaced.
What if I am not eligible for this benefit?
If you are not eligible to make an "Age 29" election, you may be able to elect COBRA/state continuation coverage for up to 36 months. You would be responsible for up to 102% of the premium. You may also be eligible to enroll in coverage through the New York State of Health Individual Marketplace.
What if I need more information about this law?
Contact the Department of Financial Services' Consumer Assistance Unit at (212) 480-6400 or 1-800-342-3736.